Journal of anesthesia
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Journal of anesthesia · Dec 2012
Preventive effect of varenicline on impairment of endothelial function in cerebral vessels induced by acute smoking in rats.
Preoperative smoking cessation is important for recovery from surgery without complications. Available evidence suggests nicotine replacement therapy could be safe and effective in the perioperative period. On the other hand, the newly developed selective nicotinic acetylcholine (ACh) receptor partial agonist, varenicline tartrate, is also effective as an aid for smoking cessation and helps people to stop smoking. ⋯ Under control conditions, cerebral pial arterioles were dose-relatedly dilated by ACh. After smoking, 10(-5) M ACh constricted the arterioles following saline pretreatment (diameter -7.6 ± 1.8 %, n = 6), but induced dilation following varenicline pretreatment (diameter +15.3 ± 3.3 %, n = 6). Thus, varenicline may prevent the smoking-induced impairment of endothelium-dependent vasodilation in cerebral pial arterioles.
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Journal of anesthesia · Dec 2012
Case ReportsA case of coronary artery spasm caused by manipulation of the neck: heart rate variability analysis.
A 66-year-old man with no history of ischemic heart disease underwent cervical lymph node dissection. General anesthesia was induced and maintained with remifentanil, along with propofol. With manipulation of the neck and a subcutaneous injection of lidocaine supplemented with adrenaline before the operation, a sudden decrease in blood pressure (BP) and elevation of the ST-T segment appeared on the monitoring electrocardiogram (ECG). ⋯ Following an injection of atropine, the changes in ECG and BP were attenuated. Heart rate variability (HRV) was analyzed using fully recorded monitor variables, and revealed an increase in the high-frequency domain at the time of the cervical manipulation, suggesting simultaneous vagal stimulation and coronary artery spasm. We concluded that the cervical manipulation had increased the vagal tone and we note that HRV analysis was useful to interpret this coronary event.
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Journal of anesthesia · Dec 2012
Randomized Controlled Trial Comparative StudyComparison of the effects of intranasal midazolam versus different doses of intranasal ketamine on reducing preoperative pediatric anxiety: a prospective randomized clinical trial.
To compare the effects of intranasal midazolam versus different doses of intranasal ketamine on reducing preoperative pediatric anxiety. ⋯ Intranasal midazolam was more effective than low- or high-dose intranasal ketamine in reducing preoperative pediatric anxiety. The lower dose of ketamine reduced preoperative anxiety more than a higher dose of ketamine, which may be clinically insignificant.
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Journal of anesthesia · Dec 2012
Randomized Controlled TrialPenehyclidine enhances the efficacy of tropisetron in prevention of PONV following gynecological laparoscopic surgery.
Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Because monotherapy with antiemetics is insufficient, combinations of various antiemetics are often recommended by experts. In this study, our purpose was to find out whether penehyclidine could enhance the efficacy of tropisetron in preventing PONV. ⋯ Penehyclidine showed less efficacy in preventing PONV than tropisetron; however, compared with tropisetron or penehyclidine monotherapy, prophylactic medication with tropisetron plus penehyclidine significantly reduced the incidence of vomiting and decreased the intensity of nausea in women undergoing gynecological laparoscopic surgery.
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Journal of anesthesia · Dec 2012
Case ReportsUnexpected double-primary aortoenteric fistula resulting in massive bleeding after induction of anesthesia.
We report a case of a patient with a double-primary aortoenteric fistula with an abdominal aortic aneurysm. A 75-year-old man was taken to the operating room for the repair of an abdominal aortic aneurysm and a suspected aortoenteric fistula between the aorta and sigmoid colon. ⋯ Primary aortoenteric fistula is extremely rare and difficult to diagnose, and may cause fatal bleeding. The possibility of the presence of aortoenteric fistula, including multiple types, should be considered in the anesthetic management of abdominal aortic aneurysm.